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  • AAO PPP Cornea/External Disease Committee, Hoskins Center for Quality Eye Care
    Cornea/External Disease
    Compendium Type: I

    By the American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease Committee: Guillermo Amescua, MD,1 Esen K. Akpek, MD,2 Marjan Farid, MD,3 Francisco J. Garcia-Ferrer, MD,4 Amy Lin, MD,5 Michelle K. Rhee, MD,6 Divya Varu, MD7 David C. Musch, PhD, MPH,8 Steven P. Dunn, MD,9 Francis S. Mah, MD10

    As of November 2015, the PPPs are initially published online-only in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the PPP on the journal's site. Click here to access the journal's PPP collection page.

    1 Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami Florida
    2 The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
    3 Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, California
    4 Mercy Clinic Eye Specialists, St. Louis, Missouri
    5 John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
    6 Department of Ophthalmology Icahn School of Medicine at Mount Sinai, New York, New York
    Dell Laser Consultants, Austin, Texas
    Department of Opthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
    Michigan Cornea Consultants, P.C., Southfield, Michigan
    10 Departments of Cornea and External Diseases, Scripps Clinic Torrey Pines, La Jolla, California


    In the management of ocular surface disease, it is helpful to distinguish blepharitis and meibomian gland dysfunction (MGD) from aqueous deficient dry eye. Worsening of symptoms in the morning is typical of blepharitis, whereas worsening of the symptoms later in the day are typical of aqueous deficient dry eye.

    Blepharitis is typically a chronic condition that cannot be permanently cured, and successful management is dependent on patient compliance with a treatment regimen. This should be explained to the affected patient.

    Topical antibiotic ointments with or without corticosteroids or oral antibiotics can be used effectively in the treatment of blepharitis. Although azithromycin is used as a treatment for blepharitis, it may be hazardous when used orally in patients with cardiovascular problems. Specifically, oral azithromycin may lead to abnormalities in the electrical activity of the heart, with the potential to create serious irregularities in heart rhythm.

    In patients with blepharitis who do not respond to therapy, the possibility of carcinoma or immune-mediated diseases should be considered, particularly if the blepharitis is associated with a loss of eyelashes and/or conjunctival cicatricial changes. Early diagnosis and appropriate treatment can prevent disfigurement and may be lifesaving.

    Literature Search

    Blepharitis PPP - 2018 - Literature Search.pdf